NEWS, TIPS & BARGAINS | HEALTHY TRAVELER

Want a carefree -- and germ-free -- cruise? Be a bit vigilant

THE number of outbreaks of illness on cruise ships nearly doubled in 2006, including a spike in the last six weeks. So far this year, 36 disease outbreaks on cruise ships have been reported to the Vessel Sanitation Program of the federal Centers for Disease Control and Prevention. In 2005, there were 19.

"We've had more outbreaks in the last six weeks than we have had in quite some time," said Dave Forney, chief of the program, whose mission is to quell such outbreaks. From early November to mid-December, about a dozen sailings reported disease outbreaks.

That's because there are more outbreaks of noroviruses (a family of viruses that cause vomiting, diarrhea and stomach cramps) at sea and on land, Forney said.

The inspection program was started in the early 1970s after several disease outbreaks on ships. About twice a year, the federal program's staff inspects ships with 13 or more passengers that dock at U.S. ports. Inspectors focus on the water supply, pools and spas, food, worker hygiene and general cleanliness.

Ships are given a score: 100 is perfect and above 85 satisfactory. (The scores are posted at www.cdc.gov/nceh/vsp.) If a ship gets a score of 85 or below, it is usually reinspected in 30 to 45 days to see whether the problems were corrected.

"Cruise ships must report gastrointestinal illness," Forney said. The VSP helps when the number of ill passengers or crew reaches 2% or more of the total number of passengers or crew members aboard or when an unusual illness surfaces. When 3% or more are ill, the CDC may investigate.

Here are some frequently asked questions.

If I choose a ship that has a high score, say 98 or 100, have I eliminated my risk of getting sick?

No, Forney said. "Nowadays, there is very little correlation between sanitation scores and the risk of having a norovirus outbreak," he said. These outbreaks are common on land too, Forney said, but land-based businesses are not required to report them.

A ship with a perfect inspection score could easily have a norovirus outbreak, Forney said, because outbreaks often originate with people who are sick and board the ship. Noroviruses are found in stools or vomit of infected people, and infection can occur if you eat food or drink beverages contaminated with the virus, touch contaminated surfaces and then put your hand in your mouth, or have contact with someone infected.

Do cruise lines try to identify sick passengers before they contaminate others?

"Many cruise lines are handing out a questionnaire," Forney said, asking if any passengers are sick or have been sick in the days before sailing and urging them to get medical attention on board.

At Carnival Cruise Lines, crews observe passengers. If they look sick, they suggest that they see the ship doctor, said spokeswoman Jennifer de la Cruz. If they're too sick to sail, the line will offer a full refund or credit and help with air costs home. Annually, a handful leave because of illness, she said.

Passengers on Disney Cruise Line get a letter describing norovirus symptoms and are asked not to board if they are ill, said Rena Langley, a spokeswoman. Princess Cruises asks all arriving passengers whether they have symptoms, said Karen Candy, a spokeswoman. If they are, they will be isolated and managed on board if possible; if not, they get a refund.

Cruise lines can deny boarding to sick passengers, said Michael Crye, a spokesman for the Cruise Lines International Assn., an industry group representing 21 cruise lines.

What can I do to avoid getting sick on board?

Avoid passengers who look sick, said Roger Clemens, an adjunct professor of regulatory science at USC's School of Pharmacy who has researched noroviruses. "Wash your hands often, especially before you eat and after you shake hands," said Clemens.

To boost immunity, focus on good health habits before you start the cruise, he said. Eat right, get enough sleep, exercise and drink lots of fluids.